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Major depressive disorder — MCCQE Part 1 MCQ

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EasyDepressionMajor depressive disorderMCCQE Part 1

A 39-year-old woman has remained well for a year on venlafaxine. She stops it abruptly when her prescription runs out. Two days later she develops dizziness, nausea, vivid dreams, imbalance, and brief electric-shock sensations in her head. She has no sustained low mood, anhedonia, suicidality, fever, clonus, or substance use. What is the most appropriate management?

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Correct answer: E — Restore the previously tolerated dose, assess safety, then plan a slower individualized taper

Symptoms beginning within days of abruptly stopping short-half-life venlafaxine—imbalance, nausea, vivid dreams, dizziness, and electric-shock sensations—are characteristic of antidepressant discontinuation rather than an immediate depressive relapse. The absence of sustained depressive symptoms or a serotonergic toxidrome supports that distinction. Because symptoms are clinically important, restore the previously tolerated dose after confirming the medication history and assessing safety; discontinuation symptoms usually improve rapidly. If she still wishes to stop treatment, use shared decision-making and a slower taper over weeks or months, with smaller or more widely spaced reductions near the end and monitoring for both withdrawal and recurrence. A switch to long-acting fluoxetine is an alternative in selected difficult tapers. Abrupt cessation is not an allergy, and mislabelling withdrawal as relapse can unnecessarily prolong or escalate treatment.

Reference: CANMAT 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: https://pmc.ncbi.nlm.nih.gov/articles/PMC11351064/